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Acta Neurochirurgica

, Volume 151, Issue 3, pp 277–284 | Cite as

Spinal intradural primary germ cell tumour—review of literature and case report

  • Ahitagni Biswas
  • Tarun Puri
  • Shikha Goyal
  • Ruchika Gupta
  • Muneer Eesa
  • Pramod Kumar Julka
  • Goura Kishor Rath
Short Illustrated Review

Abstract

Background

Primary spinal cord germ cell tumour is a rare tumour. We herein review the tumour characteristics, associated risk factors, treatment policy, and patterns of failure of primary intradural germ cell tumour.

Method

We conducted a PUBMED search using a combination of keywords such as “spinal germ cell tumor,” “germinoma,” “extradural,” “intradural,” “intramedullary,” “extramedullary,” and identified 19 cases of primary spinal germ cell tumour. Clinical features, pathologic characteristics, and treatment details of these patients including status at follow-up were noted from respective case reports. We also describe a case of a young Indian patient of intradural extramedullary germ cell tumour treated with a combination of surgery, chemotherapy, and radiotherapy.

Findings

The median age at presentation was 24 years. The most common location of the tumour was thoracic (40%). β-HCG overproduction was noted in 40% of the patients. Most patients were treated with a combination of surgery, radiation therapy, and systemic chemotherapy. Median follow-up was 16.5 months. Recurrence was observed in 10% of the patients, all in β-HCG over-producing tumours. The illustrative case was a 28-year male, presenting with pain in lower back and both lower limbs for 2 months. Magnetic resonance imaging spine showed an inhomogeneous hyperintense soft tissue mass at L2-L4 spinal level. He was treated with complete surgical excision and four cycles of chemotherapy with BEP regimen following a histological diagnosis of non-seminomatous germ cell tumour. Palliative irradiation to the lumbar spine was given on progression at 3 months. The patient eventually succumbed to his condition, due to compressive transverse myelitis possibly due to cervical cord metastasis.

Conclusion

Limited surgery followed by upfront radiation therapy and adjuvant chemotherapy is the optimal management of this rare group of tumour. Omission of radiation therapy from the treatment armamentarium might engender local recurrence and spinal dissemination at first failure.

Keywords

Spinal cord Germ cell tumour Intradural Extramedullary Metastasis 

Abbreviations

ß-HCG

beta human chorionic gonadotrophin

α-FP

alpha fetoprotein

OCT4

octamer 4

PLAP

placental alkaline phosphatase

CD 30

cluster of differentiation 30

EMA

epithelial membrane antigen

STGC

syncitiotrophoblastic giant cell

Gd-DTPA

gadolinium diethylenetriamine penta-acetic acid

HMB 45

human melanoma black 45

TTF-1

thyroid transcription factor-1

F-18 FDG PET-CT

fluorine-18 fluorodeoxyglucose positron emission tomography/ computed tomography

LDH

lactate dehydrogenase

mIU

mili international unit

MRI

magnetic resonance imaging

CSF

cerebrospinal fluid

CNS

central nervous system

BEP

bleomycin, etoposide, cisplatin

CDDP

cis-diamminedichloro platinum

CSI

craniospinal irradiation

TSI

total spinal irradiation

Gy

gray

#

fraction

ICE

ifosfamide, cisplatin/ carboplatin, etoposide

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Ahitagni Biswas
    • 1
    • 4
  • Tarun Puri
    • 1
  • Shikha Goyal
    • 1
  • Ruchika Gupta
    • 2
  • Muneer Eesa
    • 3
  • Pramod Kumar Julka
    • 1
  • Goura Kishor Rath
    • 1
  1. 1.Department of RadiotherapyAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of PathologyAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of RadiologyAll India Institute of Medical SciencesNew DelhiIndia
  4. 4.Department of Radiation OncologyAll India Institute of Medical SciencesNew DelhiIndia

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